- Sutter Health (Roseville, CA)
- …SMCS-Valley Administration **Position Overview:** Conducts preauthorization, concurrent, and retrospective utilization management review using the ... and at the appropriate level of care. Coordinates the utilization management , resource management , discharge...within a managed care environment. + Comprehensive knowledge of Utilization Review , levels of care, and observation… more
- CVS Health (Sacramento, CA)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... Obstetrics experience . **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator...lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC… more
- Sutter Health (Roseville, CA)
- …case management within a managed care environment. + Comprehensive knowledge of Utilization Review , levels of care, and observation status. + Awareness of ... management , quality, ancillary services, third party payers and review agencies, claims and finance departments, Medical Directors, and contracted providers… more
- Sutter Health (Burlingame, CA)
- …case management within a managed care environment. Comprehensive knowledge of Utilization Review , levels of care, and observation status. Awareness of ... management , quality, ancillary services, third party payers and review agencies, claims and finance departments, Medical Directors, and contracted providers… more
- Elevance Health (Costa Mesa, CA)
- …required by law. **Hours:** 8-5pm PST and some Holidays. The **Med Management Nurse ** will be responsible for review of the most complex or challenging cases ... **Med Management Nurse ** **Location:** This role enables...experience and requires a minimum of 2 years clinical, utilization review , or managed care experience; or… more
- Sutter Health (Tracy, CA)
- …**Organization:** STCH-Sutter Tracy Community Hosp **Position Overview:** Coordinates the utilization management , resource management , discharge planning, ... management within a managed care environment. + Comprehensive knowledge of Utilization Review , levels of care, and observation status. + Working knowledge… more
- Cedars-Sinai (Los Angeles, CA)
- …in the inpatient and/or ambulatory setting. + Works with Inpatient Case Management and Inpatient Nursing to support and coordinate hospital discharge by working ... services provided through the value-based program such as Ambulatory Care Management . Follows and coordinates care of patients enrolled in value-based programs… more
- Sutter Health (San Francisco, CA)
- …Manager is responsible for Care Coordination, Care Transitions, Discharge Planning and Utilization Management throughout the acute care patient experience. The ... case management within a managed care environment. + Comprehensive knowledge of Utilization Review , levels of care, and observation status. + Some awareness… more
- Evolent (Sacramento, CA)
- …quality and cost effective care delivery. **What You'll Be Doing:** + Performs utilization review of outpatient procedures and ancillary services. + Fulfills on ... for the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks are… more
- VNA Health (Santa Barbara, CA)
- …in clinical education, inservice and nursing staff meetings. + Participate in Quality Management and Utilization Review Activities. + Maintain necessary ... - 7:30PM, 3 days per week, rotating weekends Job Description: The Inpatient Registered Nurse provides hospice care and is skilled at assessing pain and other complex… more